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Simsek M, Besiroglu M, Akcakaya A, Topcu A, Yasin AI, Isleyen ZS, Seker M, Turk HM. Local interventions for colorectal cancer metastases to liver and lung. Ir J Med Sci 2023; 192:2635-2641. [PMID: 36929352 DOI: 10.1007/s11845-023-03340-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Colorectal cancer is a common cause of cancer-related deaths. About 1/3 of all cases present with distant metastasis, with the liver as the leading site and the lung as the most common extra-abdominal site. AIMS It was aimed to evaluate the clinical characteristics and the outcomes of colorectal cancer patients with liver or lung metastasis who had received local treatments. METHODS This is a retrospective, cross-sectional, and descriptive study. The study was performed with colorectal cancer patients that referred to the medical oncology clinic of a university hospital between December 2013 and August 2021. RESULTS A total number of 122 patients who have received local treatments were included. Radiofrequency ablation was applied in 32 patients (26.2%), metastasis was surgically resected in 84 patients (68.9%), and stereotactic body radiotherapy was preferred in six patients (4.9%). At the first follow-up control after completion of local or multimodal treatment, no residual tumor was determined with radiological assessment in 88 patients (72.1%). The median progression-free survival (16.7 months vs 9.7 months) (p = .000) and the median overall survival (37.3 months vs 25.5 months) (p = .004) of these patients were significantly better than the patients with residual disease. CONCLUSIONS Local interventions that are applied to highly selected patients may improve the survival of metastatic colorectal cancer patients. A close follow-up after local therapies is important to diagnose recurrent disease because repeated local interventions may be possible to achieve better outcomes.
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Affiliation(s)
- Melih Simsek
- Department of Internal Medicine, Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey.
| | - Mehmet Besiroglu
- Department of Internal Medicine, Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Adem Akcakaya
- Department of General Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Atakan Topcu
- Department of Internal Medicine, Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Ayse Irem Yasin
- Department of Internal Medicine, Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Zehra Sucuoglu Isleyen
- Department of Internal Medicine, Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Mesut Seker
- Department of Internal Medicine, Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Haci Mehmet Turk
- Department of Internal Medicine, Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey
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De Baere T, Tselikas L, Delpla A, Roux C, Varin E, Kobe A, Yevich S, Deschamps F. Thermal ablation in the management of oligometastatic colorectal cancer. Int J Hyperthermia 2022; 39:627-632. [PMID: 35477367 DOI: 10.1080/02656736.2021.1941311] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To review available evidence on thermal ablation of oligometastatic colorectal cancer. METHODS Technical and cancer specific considerations for percutaneous image-guided thermal ablation of oligometastatic colorectal metastases in the liver and lung were reviewed. Ablation outcomes are compared to surgical and radiation therapy literature. RESULTS The application of thermal ablation varies widely based on tumor burden, technical expertise, and local cancer triage algorithms. Ablation can be performed in combination or in lieu of other cancer treatments. For surgically non-resectable liver metastases, a randomized trial has demonstrated the superiority of thermal ablation combined with chemotherapy compared to systemic chemotherapy alone in term of progression-free survival and overall survival (OS), with 5-, and 8-year OS of 43.1% and 35.9% in the combined arm vs. 30.3% and 8.9% in the chemotherapy alone arm. As ablation techniques and technology improve, the role of percutaneous thermal ablation may expand even into surgically resectable disease. Many of the prognostic factors for better OS after local treatment of lung metastases are the same for surgery and thermal ablation, including size and number of metastases, disease-free interval, complete resection/ablation, negative carcinoembryonic antigen, neoadjuvant chemotherapy, and controlled extra-pulmonary metastases. When matched for these factors, thermal ablation for lung and liver metastases appears to provide equivalent overall survival as surgery, in the range of 50% at 5 years. Thermal ablation has limitations that should be respected to optimize patient outcomes and minimize complications including targets that are well-visualized by image guidance, measure <3cm in diameter, and be located at least 3mm distance from prominent vasculature or major bronchi. CONCLUSIONS The routine incorporation of image-guided thermal ablation into the therapeutic armamentarium for the treatment of oligometastatic colorectal cancer can provide long survival and even cure.
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Affiliation(s)
- Thierry De Baere
- Departement d'anesthésie, de chirurgie, et de radiologie interventionnelle, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin Bicêtre, France
| | - Lambros Tselikas
- Departement d'anesthésie, de chirurgie, et de radiologie interventionnelle, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin Bicêtre, France
| | - Alexandre Delpla
- Departement d'anesthésie, de chirurgie, et de radiologie interventionnelle, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin Bicêtre, France
| | - Charles Roux
- Departement d'anesthésie, de chirurgie, et de radiologie interventionnelle, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin Bicêtre, France
| | - Eloi Varin
- Departement d'anesthésie, de chirurgie, et de radiologie interventionnelle, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin Bicêtre, France
| | - Adrian Kobe
- Departement d'anesthésie, de chirurgie, et de radiologie interventionnelle, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin Bicêtre, France
| | - Steven Yevich
- Interventional Radiology Department, MD Anderson Cancer Center, Houston, TX, USA
| | - Frederic Deschamps
- Departement d'anesthésie, de chirurgie, et de radiologie interventionnelle, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin Bicêtre, France
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Hernández J, Molins L, Fibla JJ, Guirao Á, Rivas JJ, Casas L, Pajuelo N, Embún R. Correlation between preoperative CT scan and lung metastases according to surgical approach in patients with colorectal cancer. Cir Esp 2022; 100:140-148. [PMID: 35302934 DOI: 10.1016/j.cireng.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/15/2020] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The number of lung metastases (M1) of colorectal carcinoma (CRC) in relation to the findings of computed tomography (CT) is the object of study. METHODS Prospective and multicenter study of the Spanish Group for Surgery of CRC lung metastases (GECMP-CCR). The role of CT in the detection of pulmonary M1 is evaluated in 522 patients who underwent a pulmonary metastasectomy for CRC. We define M1/CT as the ratio between metastatic nodules and those found on preoperative CT. Disease-specific survival (DSS), disease-free survival (DFS), and surgical approach were analyzed using the Kaplan-Meier method. RESULTS 93 patients were performed by video-assisted surgery (VATS) and 429 by thoracotomy. In 90%, the M1/CT ratio was ≤1, with no differences between VATS and thoracotomy (94.1% vs 89.7%, p=0.874). In the remaining 10% there were more M1s than those predicted by CT (M1/CT>1), with no differences between approaches (8.6% vs 10%, p=0.874). 51 patients with M1/CT>1, showed a lower median DSS (35.4 months vs 55.8; p=0.002) and DFS (14.2 months vs 29.3; p=0.025) compared to 470 with M1/CT≤1. No differences were observed in DSS and DFS according to VATS or thoracotomy. CONCLUSIONS Our study shows equivalent oncological results in the resection of M1 of CRC using VATS or thoracotomy approach. The group of patients with an M1/CT ratio >1 have a worse DSS and DFS, which may mean a more advanced disease than predicted preoperatively.
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Affiliation(s)
- Jorge Hernández
- Service of Thoracic Surgery, Hospital Universitari del Sagrat Cor, Barcelona, Spain.
| | - Laureano Molins
- Service of Thoracic Surgery, Hospital Universitari del Sagrat Cor, Barcelona, Spain; Service of Thoracic Surgery, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Juan J Fibla
- Service of Thoracic Surgery, Hospital Universitari del Sagrat Cor, Barcelona, Spain
| | - Ángela Guirao
- Service of Thoracic Surgery, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Juan J Rivas
- Service of Thoracic Surgery, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain
| | - Laura Casas
- Department of Biostatistics and Data Management, Dynamic Solutions, Madrid, Spain
| | - Núria Pajuelo
- Department of Biostatistics and Data Management, Dynamic Solutions, Madrid, Spain
| | - Raúl Embún
- Service of Thoracic Surgery, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain
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Treasure T, Dunning J, Williams NR, Macbeth F. Lung metastasectomy for colorectal cancer: The impression of benefit from uncontrolled studies was not supported in a randomized controlled trial. J Thorac Cardiovasc Surg 2022; 163:486-490. [PMID: 33840470 DOI: 10.1016/j.jtcvs.2021.01.142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/19/2020] [Accepted: 01/02/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, United Kingdom.
| | - Joel Dunning
- James Cook University Hospital, Middlesbrough, United Kingdom
| | - Norman R Williams
- Surgical and Interventional Trials Unit, University College London, London, United Kingdom
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
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Fenton HM, Finan PJ, Milton R, Shackcloth M, Taylor JC, Treasure T, Morris EJA. National variation in pulmonary metastasectomy for colorectal cancer. Colorectal Dis 2021; 23:1306-1316. [PMID: 33368958 PMCID: PMC8614123 DOI: 10.1111/codi.15506] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/17/2020] [Accepted: 12/04/2020] [Indexed: 12/12/2022]
Abstract
AIM Evidence on patterns of use of pulmonary metastasectomy in colorectal cancer patients is limited. This population-based study aims to investigate the use of pulmonary metastasectomy in the colorectal cancer population across the English National Health Service (NHS) and quantify the extent of any variations in practice and outcome. METHODS All adults who underwent a major resection for colorectal cancer in an NHS hospital between 2005 and 2013 were identified in the COloRECTal cancer data Repository (CORECT-R). All inpatient episodes corresponding to pulmonary metastasectomy, occurring within 3 years of the initial colorectal resection, were identified. Multi-level logistic regression was used to determine patient and organizational factors associated with the use of pulmonary metastasectomy for colorectal cancer, and Kaplan-Meier and Cox models were used to assess survival following pulmonary metastasectomy. RESULTS In all, 173 354 individuals had a major colorectal resection over the study period, with 3434 (2.0%) undergoing pulmonary resection within 3 years. The frequency of pulmonary metastasectomy increased from 1.2% of patients undergoing major colorectal resection in 2005 to 2.3% in 2013. Significant variation was observed across hospital providers in the risk-adjusted rates of pulmonary metastasectomy (0.0%-6.8% of patients). Overall 5-year survival following pulmonary resection was 50.8%, with 30-day and 90-day mortality of 0.6% and 1.2% respectively. CONCLUSIONS This study shows significant variation in the rates of pulmonary metastasectomy for colorectal cancer across the English NHS.
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Affiliation(s)
- Hayley M. Fenton
- Cancer Epidemiology GroupLeeds Institute for Data AnalyticsUniversity of LeedsLeedsUK
| | - Paul J. Finan
- Cancer Epidemiology GroupLeeds Institute for Data AnalyticsUniversity of LeedsLeedsUK
| | - Richard Milton
- Department of Thoracic SurgerySt James’s University HospitalLeedsUK
| | - Michael Shackcloth
- Department of Thoracic SurgeryLiverpool Heart and Chest HospitalLiverpoolUK
| | - John C. Taylor
- Cancer Epidemiology GroupLeeds Institute for Data AnalyticsUniversity of LeedsLeedsUK
| | - Tom Treasure
- Clinical Operational Research UnitUniversity College LondonLondonUK
| | - Eva J. A. Morris
- Nuffield Department of Population HealthBig Data InstituteUniversity of OxfordOxfordUK
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Role of Thermal Ablation in Colorectal Cancer Lung Metastases. Cancers (Basel) 2021; 13:cancers13040908. [PMID: 33671510 PMCID: PMC7927065 DOI: 10.3390/cancers13040908] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/13/2021] [Accepted: 02/18/2021] [Indexed: 12/30/2022] Open
Abstract
Simple Summary For a long time, surgery has been the only local treatment for pulmonary metastases. Percutaneous thermal ablation appeared in the early 2000s as a minimally invasive alternative technique to surgery for patients who were not eligible for surgery or wanted to preserve quality of life. In this review, we discuss the role of thermal ablation in the management of lung metastases of colorectal cancer, and present the main results of the literature concerning oncological outcomes (local tumor control, survival) based on 12 relevant original studies each involving a minimum of 50 patients, with a minimal follow-up of 12 months. Abstract Background: Consensus guidelines of the European Society for Medical Oncology (ESMO) (2016) provided recommendations for the management of lung metastases. Thermal ablation appears as a tool in the management of these secondary pulmonary lesions, in the same manner as surgical resection or stereotactic ablative radiotherapy (SABR). Methods: Indications, technical considerations, oncological outcomes such as survival (OS) or local control (LC), prognostic factors and complications of thermal ablation in colorectal cancer lung metastases were reviewed and put into perspective with results of surgery and SABR. Results: LC rates varied from 62 to 91%, with size of the metastasis (<2 cm), proximity to the bronchi or vessels, and size of ablation margins (>5 mm) as predictive factors of LC. Median OS varied between 33 and 68 months. Pulmonary free disease interval <12 months, positive carcinoembryonic antigen, absence of neoadjuvant chemotherapy and uncontrolled extra-pulmonary metastases were poor prognostic factors for OS. While chest drainage for less than 48 h was required in 13 to 47% of treatments, major complications were rare. Conclusions: Thermal ablation of a selected subpopulation of patients with colorectal cancer lung metastases is safe and can provide excellent LC and delay systemic chemotherapy.
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7
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Hernández J, Molins L, Fibla JJ, Guirao Á, Rivas JJ, Casas L, Pajuelo N, Embún R. Correlation between preoperative CT scan and lung metastases according to surgical approach in patients with colorectal cancer. Cir Esp 2021; 100:S0009-739X(20)30426-7. [PMID: 33516524 DOI: 10.1016/j.ciresp.2020.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/06/2020] [Accepted: 12/15/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The number of lung metastases (M1) of colorectal carcinoma (CRC) in relation to the findings of computed tomography (CT) is the object of study. METHODS Prospective and multicenter study of the Spanish Group for Surgery of CRC lung metastases (GECMP-CCR). The role of CT in the detection of pulmonary M1 is evaluated in 522 patients who underwent a pulmonary metastasectomy for CRC. We define M1/CT as the ratio between metastatic nodules and those found on preoperative CT. Disease-specific survival (DSS), disease-free survival (DFS), and surgical approach were analyzed using the Kaplan-Meier method. RESULTS 93 patients were performed by video-assisted surgery (VATS) and 429 by thoracotomy. In 90%, the M1/CT ratio was ≤1, with no differences between VATS and thoracotomy (94.1% vs 89.7%, p=0.874). In the remaining 10% there were more M1s than those predicted by CT (M1/CT>1), with no differences between approaches (8.6% vs 10%, p=0.874). 51 patients with M1/CT>1, showed a lower median DSS (35.4 months vs 55.8; p=0.002) and DFS (14.2 months vs 29.3; p=0.025) compared to 470 with M1/CT≤1. No differences were observed in DSS and DFS according to VATS or thoracotomy. CONCLUSIONS Our study shows equivalent oncological results in the resection of M1 of CRC using VATS or thoracotomy approach. The group of patients with an M1/CT ratio >1 have a worse DSS and DFS, which may mean a more advanced disease than predicted preoperatively.
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Affiliation(s)
- Jorge Hernández
- Service of Thoracic Surgery, Hospital Universitari del Sagrat Cor, Barcelona, Spain.
| | - Laureano Molins
- Service of Thoracic Surgery, Hospital Universitari del Sagrat Cor, Barcelona, Spain; Service of Thoracic Surgery, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Juan J Fibla
- Service of Thoracic Surgery, Hospital Universitari del Sagrat Cor, Barcelona, Spain
| | - Ángela Guirao
- Service of Thoracic Surgery, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Juan J Rivas
- Service of Thoracic Surgery, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain
| | - Laura Casas
- Department of Biostatistics and Data Management, Dynamic Solutions, Madrid, Spain
| | - Núria Pajuelo
- Department of Biostatistics and Data Management, Dynamic Solutions, Madrid, Spain
| | - Raúl Embún
- Service of Thoracic Surgery, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain
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8
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Murakawa T. Past, present, and future perspectives of pulmonary metastasectomy for patients with advanced colorectal cancer. Surg Today 2020; 51:204-211. [PMID: 32857252 DOI: 10.1007/s00595-020-02119-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/15/2020] [Indexed: 12/16/2022]
Abstract
Over a half-century has passed since Thomford et al. proposed the selection criteria for pulmonary metastasectomy, and several prognostic factors have been identified. Although screening modalities and operations have changed dramatically, the important concepts of the selection criteria remain unchanged. Recent improvements in the survival outcomes of colorectal cancer patients undergoing pulmonary metastasectomy may be the result of strict adherence to the selection criteria for oligometastatic lung tumors, which can mimic local disease. Pulmonary metastasectomy has become an important option for selected patients with oligometastasis, based mainly on a large amount of retrospective data, but its effect on survival remains unclear. Curable pulmonary metastasis might be regarded as a "semi-local disease" under the spontaneous control of an acquired alteration in host immune status. The current practice of pulmonary metastasectomy for colorectal cancer focuses on selecting the most appropriate operation for selected patients. However, in the rapidly evolving era of immunotherapy, treatment-naïve patients for whom surgery is not suitable might be pre-conditioned by immunotherapy so that they may be considered for salvage surgery.
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Affiliation(s)
- Tomohiro Murakawa
- Department of Thoracic Surgery, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1010, Japan.
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9
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Chen J, Zeng Z, Huang L, Luo S, Dong J, Zhou FH, Zhou K, Wang L, Kang L. Photothermal therapy technology of metastatic colorectal cancer. Am J Transl Res 2020; 12:3089-3115. [PMID: 32774688 PMCID: PMC7407689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/17/2020] [Indexed: 06/11/2023]
Abstract
Colorectal cancer (CRC) is one of the most common malignancies. The current treatments of metastatic colorectal cancer (mCRC) are ineffective and the bottleneck problem. It is of significance to explore effective new therapeutic strategies to eradicate mCRC. Photothermal therapy (PTT) is an emerging technology for tumor therapy, with the potential in the treatment of mCRC. In this review, the current treatment approaches to mCRC including surgery, radiotherapy, chemotherapy interventional therapy, biotherapy, and photothermal therapy are reviewed. In addition, we will focus on the various kinds of nanomaterials used in PTT for the treatment of CRC both in vitro and in vivo models. In conclusion, we will summarize the combined application of PTT with other theranostic methods, and propose future research directions of PTT in the treatment of CRC.
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Affiliation(s)
- Junji Chen
- Department of Colorectal Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510655, Guangdong, China
- Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510655, Guangdong, China
| | - Ziwei Zeng
- Department of Colorectal Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510655, Guangdong, China
- Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510655, Guangdong, China
| | - Liang Huang
- Department of Colorectal Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510655, Guangdong, China
- Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510655, Guangdong, China
| | - Shuangling Luo
- Department of Colorectal Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510655, Guangdong, China
- Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510655, Guangdong, China
| | - Jianghui Dong
- UniSA Clinical and Health Sciences, and UniSA Cancer Research Institute, University of South AustraliaAdelaide, SA 5001, Australia
| | - Fiona H Zhou
- School of Medicine, University of AdelaideAdelaide, SA 5000, Australia
| | - Kun Zhou
- UniSA Clinical and Health Sciences, and UniSA Cancer Research Institute, University of South AustraliaAdelaide, SA 5001, Australia
| | - Liping Wang
- UniSA Clinical and Health Sciences, and UniSA Cancer Research Institute, University of South AustraliaAdelaide, SA 5001, Australia
| | - Liang Kang
- Department of Colorectal Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510655, Guangdong, China
- Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510655, Guangdong, China
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Dudek W, Schreiner W, Mykoliuk I, Higaze M, Sirbu H. Pulmonary metastasectomy for sarcoma-survival and prognostic analysis. J Thorac Dis 2019; 11:3369-3376. [PMID: 31559040 DOI: 10.21037/jtd.2019.08.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Pulmonary metastasectomy (PM) has commonly been performed in patients with controlled metastatic sarcoma. We reviewed our single-institution experience with pulmonary resections for sarcoma to analyse clinical outcome and to identify prognostic factors associated with patient survival. Methods All sarcoma patients undergoing curative intent PM between 2008 and 2014 were retrospectively analysed. Factors related to primary tumour, metastases, applied therapy, systematic inflammation and preoperative nutritional condition, associated with survival after PM were evaluated using the univariable Cox proportional hazard model. Cut-off values of continuous variables were determined by a receiver operating characteristic (ROC) analysis. Results In total, 33 patients (19 male and 14 female, median age 55 years) underwent PM for metastatic sarcoma. There were no perioperative deaths; major complications occurred in 5 (15.2%) patients. The median interval between the treatment of primary tumour and PM was 16 months (range, 0-171 months). The median size of the largest pulmonary lesion was 1.3 cm. Mean follow-up was 37 months (range, 1-100 months) and the 5-year overall survival (OS) rate after first PM was 40.4%. Resection was complete (R0) in 31 (93.9%) patients. In univariable analysis, a shorter interoperative interval [<30 months, hazard ratio (HR) 5.05, 95% confidence interval (CI): 1.15-22.19] and grade 3 (G3) sarcoma (HR 3.52, 95% CI: 1.01-12.25) were significant negative prognosticators. Conclusions Despite the lack of randomized controlled trials PM for sarcomatous disease is a reasonable therapeutic option with acceptable survival in a selected patient population. In sarcoma patients with a shorter interoperative interval and G3 tumour, shorter survival after PM can be expected.
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Affiliation(s)
- Wojciech Dudek
- Department of Thoracic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Waldemar Schreiner
- Department of Thoracic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Iurii Mykoliuk
- Department of Thoracic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Mostafa Higaze
- Department of Thoracic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Horia Sirbu
- Department of Thoracic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Pastorino U, Morelli D, Leuzzi G, Rolli L, Suatoni P, Taverna F, Bertocchi E, Boeri M, Sozzi G, Cantarutti A, Corrao G, Gronchi A. Baseline and Postoperative C-reactive Protein Levels Predict Long-Term Survival After Lung Metastasectomy. Ann Surg Oncol 2019; 26:869-875. [DOI: 10.1245/s10434-018-07116-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Indexed: 01/13/2023]
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12
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Individual data meta-analysis for the study of survival after pulmonary metastasectomy in colorectal cancer patients: A history of resected liver metastases worsens the prognosis. Eur J Surg Oncol 2018; 44:1006-1012. [DOI: 10.1016/j.ejso.2018.03.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/01/2018] [Accepted: 03/14/2018] [Indexed: 12/17/2022] Open
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Zellweger M, Abdelnour-Berchtold E, Krueger T, Ris HB, Perentes JY, Gonzalez M. Surgical treatment of pulmonary metastasis in colorectal cancer patients: Current practice and results. Crit Rev Oncol Hematol 2018; 127:105-116. [PMID: 29891107 DOI: 10.1016/j.critrevonc.2018.05.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/12/2018] [Accepted: 05/07/2018] [Indexed: 12/13/2022] Open
Abstract
Colorectal cancer (CRC) is a frequently occurring disease, yet diagnosed at a local stage in only 40% of cases. Lung metastases (LM) appear in 5-15% of patients and, left untreated, carry a very poor prognosis. Some CRC patients may benefit from a potentially curative LM resection, but success and benefit are difficult to predict. We discuss prognostic factors of survival after lung metastasectomy in CRC patients under several scenarios (with/ without prior liver metastases; repetitive pulmonary resections). We reviewed all studies (2005-2015) about pulmonary metastases surgical management with curative intent in CRC patients, with a minimum threshold on the number of patients reported (without prior liver metastases: n ≥ 100; with prior resection of liver metastases: n ≥ 50; repetitive thoracic surgery: n ≥ 30). The picture of the prognostic factors of survival is nuanced: surgical management demonstrates clear successes and steady progress, yet there is no single success criterion; stratification of patients and selection bias impact the conclusions. Surgical management of liver and lung metastases may prolong life or cure CRC patients, provided the lesions are fully resected and patients carefully selected. Repeat lung metastasectomy is a safe approach to treat patients in selected cases. In conclusion, there is no standard for surgical management in CRC patients with pulmonary metastases. Patients with isolated unilateral lung metastasis with normal CEA level and no lymph node involvement benefit the most from surgery. Most series report good results in highly selected patients, but instances of long-term disease-free survival remain exceptional.
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Affiliation(s)
- Matthieu Zellweger
- Division of Thoracic Surgery, Centre Hospitalier Vaudois (CHUV), Lausanne, Switzerland.
| | | | - Thorsten Krueger
- Division of Thoracic Surgery, Centre Hospitalier Vaudois (CHUV), Lausanne, Switzerland.
| | - Hans-Beat Ris
- Division of Thoracic Surgery, Centre Hospitalier Vaudois (CHUV), Lausanne, Switzerland.
| | - Jean Yannis Perentes
- Division of Thoracic Surgery, Centre Hospitalier Vaudois (CHUV), Lausanne, Switzerland.
| | - Michel Gonzalez
- Division of Thoracic Surgery, Centre Hospitalier Vaudois (CHUV), Lausanne, Switzerland.
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Microwave Ablation in the Management of Colorectal Cancer Pulmonary Metastases. Cardiovasc Intervent Radiol 2018; 41:1530-1544. [PMID: 29845348 DOI: 10.1007/s00270-018-2000-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/23/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE To review outcomes following microwave ablation (MWA) of colorectal cancer pulmonary metastases and assess predictors of oncologic outcomes. METHODS Technical success, primary and secondary technique efficacy rates were evaluated for 50 patients with 90 colorectal cancer pulmonary metastases at immediate, 4-8 weeks post-MWA and subsequent follow-up CT and/or 18F-FDG PET/CT. Local tumor progression (LTP) rate, LTP-free survival (LTPFS), cancer-specific and overall survivals were assessed. Complications were recorded according to SIR classification. RESULTS Median follow-up was 25.6 months. Median tumor size was 1 cm (0.3-3.2 cm). Technical success, primary and secondary technique efficacy rates were 99, 90 and 92%, respectively. LTP rate was 10%. One-, 2- and 3-year LTPFS were: 93, 86 and 86%, respectively, with median LTPFS not reached. Median overall survival was 58.6 months, and median cancer-specific survival (CSS) was not reached. One-, 2- and 3-year overall and CSS were 94% and 98, 82 and 90%, 61 and 70%, respectively. On univariate analysis, minimal ablation margin (p < 0.001) and tumor size (p = 0.001) predicted LTPFS, with no LTP for minimal margin ≥ 5 mm and/or tumor size < 1 cm. Pleural-based metastases were associated with increased LTP risk (p = 0.002, SHR = 7.7). Pre-MWA CEA level > 10 ng/ml (p = 0.046) and ≥ 3 prior chemotherapy lines predicted decreased CSS (p = 0.02). There was no 90-day death. Major complications rate was 13%. CONCLUSIONS MWA with minimal ablation margin ≥ 5 mm is essential for local control of colorectal cancer pulmonary metastases. Pleural-based metastases and larger tumor size were associated with higher risk of LTP. CEA level and pre-MWA chemotherapy impacted CSS.
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15
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Smolenov EI, Ragulin YA, Pikin OV, Ryabov A. [Pulmonary metastases: classification and the need for staging?]. Khirurgiia (Mosk) 2018:22-26. [PMID: 29652318 DOI: 10.17116/hirurgia20183222-26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To analyze pulmonary metastases classifications which are used in Russian and foreign literature at present time. MATERIAL AND METHODS It is proposed the variant of pulmonary metastases staging depending on quantitative and regional prevalence of the process. RESULTS The development of pulmonary metastases classification is advisable to determine homogeneous subgroups of patients with metastatic lesion for prospective randomized trials in order to obtain objective results about the results of surgical or other local treatment of patients with intrapulmonary metastases.
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Affiliation(s)
- E I Smolenov
- P.A. Herzen Moscow Oncology Research Institute, Branch, National Medical Radiology Research Center, Ministry of Health of Russia, Moscow, Russia ,A.F. Tsyb Medical Radiology Research Center, Branch, National Medical Radiology Research Center, Ministry of Health of Russia, Obninsk, Russia
| | - Yu A Ragulin
- P.A. Herzen Moscow Oncology Research Institute, Branch, National Medical Radiology Research Center, Ministry of Health of Russia, Moscow, Russia ,A.F. Tsyb Medical Radiology Research Center, Branch, National Medical Radiology Research Center, Ministry of Health of Russia, Obninsk, Russia
| | - O V Pikin
- P.A. Herzen Moscow Oncology Research Institute, Branch, National Medical Radiology Research Center, Ministry of Health of Russia, Moscow, Russia ,A.F. Tsyb Medical Radiology Research Center, Branch, National Medical Radiology Research Center, Ministry of Health of Russia, Obninsk, Russia
| | - A Ryabov
- P.A. Herzen Moscow Oncology Research Institute, Branch, National Medical Radiology Research Center, Ministry of Health of Russia, Moscow, Russia ,A.F. Tsyb Medical Radiology Research Center, Branch, National Medical Radiology Research Center, Ministry of Health of Russia, Obninsk, Russia
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16
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Jarabo JR, Gómez AM, Calatayud J, Fraile CA, Fernández E, Pajuelo N, Embún R, Molins L, Rivas JJ, Hernando F. Combined Hepatic and Pulmonary Metastasectomies From Colorectal Carcinoma. Data From the Prospective Spanish Registry 2008–2010. Arch Bronconeumol 2018; 54:189-197. [DOI: 10.1016/j.arbres.2017.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/03/2017] [Accepted: 10/26/2017] [Indexed: 01/02/2023]
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17
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Kim JY, Park IJ, Kim HR, Kim DK, Lee JL, Yoon YS, Kim CW, Lim SB, Lee JB, Yu CS, Kim JC. Post-pulmonary metastasectomy prognosis after curative resection for colorectal cancer. Oncotarget 2018; 8:36566-36577. [PMID: 28402263 PMCID: PMC5482677 DOI: 10.18632/oncotarget.16616] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/12/2017] [Indexed: 12/23/2022] Open
Abstract
Purpose We aimed to compare disease-free survival after pulmonary metastasectomy to that after hepatic metastasectomy, and to identify prognostic factors after pulmonary metastasectomy. Results Between 2005 and 2015, 129 patients underwent resection of isolated metachronous lung metastases from colorectal cancer. Three-year DFS after pulmonary metastasectomy was similar to that after hepatic metastasectomy (50.7% vs. 45.5%, respectively; p=0.58). Rectal cancer (hazard ratio [HR]: 2.04, 95% confidence interval [CI]: 1.09–3.79; p=0.03) and ≥2 metastases (HR: 2.17, 95% CI: 1.28–3.68; p=0.004) were independent adverse risk factors associated with disease-free survival after pulmonary metastasectomy on multivariate analysis. Three-year DFS for colon vs. rectal cancer patients was 72.5% vs. 42.6%, respectively (p=0.04). The number of lung metastases was an independent risk factor for DFS after pulmonary metastasectomy in rectal cancer patients. Patients and Methods Patients who underwent lung metastasectomy after curative resection of colorectal cancers were investigated. Disease-free survival (DFS) after pulmonary metastasectomy was compared to that after hepatic metastasectomy, which has a relatively well-known prognosis. Multivariate Cox proportional hazards analysis was performed to identify clinical variables predictive of survival after pulmonary metastasectomy. Conclusions Disease-free survival rates after resection of lung vs. liver metastases arising from colorectal cancers are similar. However, lung metastases specifically from rectal cancers produce poorer DFS rates. Primary tumor location must be considered for pulmonary metastasis treatment and follow-up in colorectal cancer patients.
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Affiliation(s)
- Jee Yeon Kim
- Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - In Ja Park
- Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Jong Lyul Lee
- Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Yong Sik Yoon
- Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Chan Wook Kim
- Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Seok-Byung Lim
- Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Jung Bok Lee
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Chang Sik Yu
- Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Jin Cheon Kim
- Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
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18
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Porrello C, Gullo R, Vaglica A, Scerrino G, Salamone G, Licari L, Raspanti C, Gulotta E, Gulotta G, Cocorullo G. Pulmonary Laser Metastasectomy by 1318-nm Neodymium-Doped Yttrium-Aluminum Garnet Laser: A Retrospective Study About Laser Metastasectomy of the Lung. Surg Innov 2018; 25:142-148. [PMID: 29347883 DOI: 10.1177/1553350617752263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The lungs are among the first organ affected by remote metastases from many primary tumors. The surgical resection of isolated pulmonary metastases represents an important and effective element of therapy. This is a retrospective study about our entire experience with pulmonary resection for metastatic cancer using 1318-nm neodymium-doped yttrium-aluminum garnet laser. METHOD In this single-institution study, we retrospectively analyzed a group of 209 patients previously treated for primary malignant solid tumors. We excluded 103 patients. The number and location of lesions in the lungs was determined using chest computed tomography and positron emission tomography-computed tomography. Disseminated malignancy was excluded. All pulmonary laser resections are performed via an anteroaxillary muscle-sparing thoracotomy. All lesions were routinely removed by laser with a small (5-10 mm) margin of the healthy lung. Patients received systematic lymph node sampling with intraoperative smear cytology of sampled lymph nodes. RESULTS Mortality at 2 years from the first surgery is around 20% (10% annually). This value increases to 45% in the third year. The estimated median survival for patients who underwent the first surgery is reported to be approximately 42 months. CONCLUSION Our results show that laser resection of lung metastases can achieve good result, in terms of radical resection and survival, as conventional surgical metastasectomy. The great advantage is the possibility of limiting the damage to the lung. Stapler resection of a high number of metastases would mutilate the lung.
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19
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Abstract
Surgical treatment of metastatic colorectal cancer offers a chance for cure or prolonged survival, particularly for those with more favorable prognostic factors and limited tumor burden. The treatment plan requires multidisciplinary evaluation because multiple therapy options exist. Advanced surgical techniques, adjuncts to resection, and modern chemotherapy all contribute to best outcomes for patients with hepatic metastases. Although cure is less common for patients with metastasis to lung or peritoneum, surgical resection for the former and cytoreduction and intraperitoneal chemotherapy for the latter may help to achieve cancer control in selected patients.
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Affiliation(s)
- Jeffery Chakedis
- Division of Surgical Oncology, Department of Surgery, Complex General Surgical Oncology, The Ohio State University Wexner Medical Center, Arthur G. James Cancer Hospital and Solove Research Institute, 395 West 12th Avenue, Suite 670, Columbus, OH 43210-1267, USA
| | - Carl R Schmidt
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Arthur G. James Cancer Hospital and Solove Research Institute, 395 West 12th Avenue, Suite 670, Columbus, OH 43210-1267, USA.
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20
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Shiono S, Okumura T, Boku N, Hishida T, Ohde Y, Sakao Y, Yoshiya K, Hyodo I, Mori K, Kondo H. Outcomes of segmentectomy and wedge resection for pulmonary metastases from colorectal cancer. Eur J Cardiothorac Surg 2017; 51:504-510. [PMID: 27773868 DOI: 10.1093/ejcts/ezw322] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 08/10/2016] [Indexed: 01/01/2023] Open
Abstract
Objectives Although wedge resection is the most common surgical procedure for pulmonary metastases from colorectal cancer, there are few reports about segmentectomy for colorectal metastasectomy. Methods This was a subset analysis of a Japanese nationwide retrospective study of resected pulmonary metastases from colorectal cancer. The study included 553 patients who underwent segmentectomies ( n = 98) or wedge resections ( n = 455) without preoperative chemotherapy between January 2004 and December 2008. Recurrence patterns, recurrence-free survival and overall survival were analysed for each procedure. Results As for the patients' background factors, only the median size of resected metastases was different between patients with segmentectomies (median 18 mm, range 5-50 mm) and wedge resections (14 mm, 5-51 mm) ( P < 0.001). Prolonged air leak developed more frequently in those undergoing segmentectomy compared with wedge resection (5.1% vs 1.8%) ( P = 0.048). The resection-margin recurrence rate was higher in patients who underwent wedge resection compared with segmentectomy (7.3% vs 2.0%; P = 0.035). The 5-year recurrence-free survival was 48.8% in patients with segmentectomy and 36.0% in patients with wedge resections. The 5-year overall survival was 80.1% in patients with segmentectomy and 68.5% in patients with wedge resection. Multivariable analysis revealed that the surgical procedure, segmentectomy, was a significant favourable factor for recurrence (hazard ratio: 0.63, 95% confidence interval: 0.44-0.87, P = 0.005), but not for overall survival (hazard ratio: 0.65, 95% confidence interval: 0.38-1.05, P = 0.080). Conclusions Segmentectomy demonstrated a good efficacy with less resection-margin recurrence in patients with resectable pulmonary-limited metastasis from colorectal cancer.
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Affiliation(s)
- Satoshi Shiono
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Takehiro Okumura
- Department of Surgery, School of Medicine, University Hospital Mizonokuchi, Teikyo University, Kanagawa, Japan
| | - Narikazu Boku
- Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoyuki Hishida
- Department of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Yasuhisa Ohde
- Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yukinori Sakao
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Katsuo Yoshiya
- Department of Chest Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Ichinosuke Hyodo
- Division of Gastroenterology Clinical Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Keita Mori
- Clinical Research Support Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Haruhiko Kondo
- General Thoracic Surgery, School of Medicine, Kyorin University, Tokyo, Japan
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21
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unity (CORU) and Surgical and Interventional Trials Unit (SITU), University College London, London WC1E 6BT, UK
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22
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Zabaleta J, Aguinagalde B, Lopez I, Fernandez-Monge A, Izquierdo JM, Emparanza JI. Survival after pulmonary metastasectomy in colorectal cancer patients: does a history of resected liver metastases worsen the prognosis? A literature review. Cancer Biol Med 2017; 14:281-286. [PMID: 28884044 PMCID: PMC5570604 DOI: 10.20892/j.issn.2095-3941.2017.0073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective : To assess the impact of past liver metastases on the survival duration of patients who are undergoing surgery for lung metastases. Methods : We conducted a review of literature published from 2007 to 2014. The studies were identified by searching PubMed, MEDLINE, and Embase and were supplemented by a manual search of the references listed by the retrieved studies. The following search terms were used: lung metastasectomy, pulmonary metastasectomy, lung metastases, and lung metastasis. We selected retrospective and prospective studies published from 2007 to 2014 on patients with lung metastases from colorectal cancer and were undergoing surgery with curative intent. We excluded reviews, studies that focused on surgical techniques, patients who were treated non-surgically, analyses of specific subgroups of patients, and those that did not report follow-up of the patients undergoing surgery. Results : We identified 28 papers that assessed survival after lung metastases, 21 of which were mostly retrospective studies that identified previous liver metastases to explore their impact on patient survival. In more than half of the papers analyzed (63.2%), patients with a history of resected liver metastases had a lower survival rate than those who did not have such a history, and the difference was statistically significant in eight of these studies. However, data were presented differently, and authors reported mean survival time, survival rates, or hazard ratios. Conclusions : A history of liver metastases seems to be a negative prognostic factor, but the individual data need to undergo a meta-analysis.
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Affiliation(s)
- Jon Zabaleta
- Thoracic surgery service, Hospital Universitario, Donostia, Gipuzkoa 20014, Spain
| | - Borja Aguinagalde
- Thoracic surgery service, Hospital Universitario, Donostia, Gipuzkoa 20014, Spain
| | - Iker Lopez
- Thoracic surgery service, Hospital Universitario, Donostia, Gipuzkoa 20014, Spain
| | | | - Jose M Izquierdo
- Thoracic surgery service, Hospital Universitario, Donostia, Gipuzkoa 20014, Spain
| | - Jose I Emparanza
- Thoracic surgery service, Hospital Universitario, Donostia, Gipuzkoa 20014, Spain
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23
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Pulmonary metastasectomy in elderly colorectal cancer patients: a retrospective single center study. Updates Surg 2016; 68:357-367. [DOI: 10.1007/s13304-016-0399-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 09/19/2016] [Indexed: 12/20/2022]
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24
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Stereotactic Body Radiotherapy (SBRT) Is as Yet of Unproven Benefit for Patients With Lung Metastases. Am J Clin Oncol 2016; 39:423-4. [PMID: 27465426 DOI: 10.1097/coc.0000000000000279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Åberg T, Treasure T. Analysis of pulmonary metastasis as an indication for operation: an evidence-based approach. Eur J Cardiothorac Surg 2016; 50:792-798. [PMID: 27369120 DOI: 10.1093/ejcts/ezw140] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Torkel Åberg
- Clinical Operational Research Unit, University College, London, UK
| | - Tom Treasure
- Clinical Operational Research Unit, University College, London, UK
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26
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Embun R, Rivas de Andrés JJ, Call S, de Olaiz Navarro B, Freixinet JL, Bolufer S, Jarabo JR, Pajuelo N, Molins L, Rivas JJ, Molins L, Embun R, Rivas-Doyague F, Embun R, Hernández-Ferrández J, Heras F, de la Cruz J, Rubio M, Fernández E, Carbajo M, Peñalver R, Jarabo JR, González-Rivas D, Bolufer S, Pagés C, Call S, Smith D, Wins R, Arnau A, Arroyo A, Marrón C, Tamura A, Blanco M, de Olaiz B, Muñoz G, García Prim JM, Rombolá C, García-Barajas S, Rodríguez-Fuster A, Freixinet JL, Ruiz-Zafra J, Carriquiry G, Rosenberg M, Canalís E. Causal Model of Survival After Pulmonary Metastasectomy of Colorectal Cancer: A Nationwide Prospective Registry. Ann Thorac Surg 2016; 101:1883-90. [DOI: 10.1016/j.athoracsur.2015.12.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 11/28/2015] [Accepted: 12/09/2015] [Indexed: 12/17/2022]
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Migliore M, Gonzalez M. Looking forward lung metastasectomy-do we need a staging system for lung metastases? ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:124. [PMID: 27127777 DOI: 10.21037/atm.2016.03.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Marcello Migliore
- 1 Section of Thoracic Surgery, Department of Surgery and Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy ; 2 Section of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois-1011, Lausanne, Switzerland
| | - Michel Gonzalez
- 1 Section of Thoracic Surgery, Department of Surgery and Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy ; 2 Section of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois-1011, Lausanne, Switzerland
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28
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Hernández J, Molins L, Fibla JJ, Heras F, Embún R, Rivas JJ. Role of major resection in pulmonary metastasectomy for colorectal cancer in the Spanish prospective multicenter study (GECMP-CCR). Ann Oncol 2016; 27:850-5. [PMID: 27113270 DOI: 10.1093/annonc/mdw064] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 02/06/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Patients with pulmonary metastases from colorectal cancer (CRC) may benefit from aggressive surgical therapy. The objective of this study was to determine the role of major anatomic resection for pulmonary metastasectomy to improve survival when compared with limited pulmonary resection. PATIENTS AND METHODS Data of 522 patients (64.2% men, mean age 64.5 years) who underwent pulmonary resections with curative intent for CRC metastases over a 2-year period were reviewed. All patients were followed for a minimum of 3 years. Disease-specific survival (DSS) and disease-free survival (DFS) were assessed with the Kaplan-Meier method. Factors associated with DSS and DFS were analyzed using a Cox proportional hazards regression model. RESULTS A total of 394 (75.6%) patients underwent wedge resection, 19 (3.6%) anatomic segmentectomy, 5 (0.9%) lesser resections not described, 100 (19.3%) lobectomy, and 4 (0.8%) pneumonectomy. Accordingly, 104 (19.9%) patients were treated with major anatomic resection and 418 (80.1%) with lesser resection. Operations were carried out with video-assisted thoracoscopic surgery (VATS) in 93 patients. The overall DSS and DFS were 55 and 28.3 months, respectively. Significant differences in DSS and DFS in favor of major resection versus lesser resection (DSS median not reached versus 52.2 months, P = 0.03; DFS median not reached versus 23.9 months, P < 0.001) were found. In the multivariate analysis, major resection appeared to be a protective factor in DSS [hazard ratio (HR) 0.6, 95% confidence interval (CI) 0.41-0.96, P = 0.031] and DFS (HR 0.5, 95% CI 0.36-0.75, P < 0.001). The surgical approach (VATS versus open surgical resection) had no effect on outcome. CONCLUSION Major anatomic resection with lymphadenectomy for pulmonary metastasectomy can be considered in selected CRC patient with sufficient functional reserve to improve the DSS and DFS. Further prospective randomized studies are needed to confirm the present results.
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Affiliation(s)
- J Hernández
- Thoracic Surgery Units, Hospital Universitari del Sagrat Cor, Barcelona
| | - L Molins
- Thoracic Surgery Units, Hospital Universitari del Sagrat Cor, Barcelona
| | - J J Fibla
- Thoracic Surgery Units, Hospital Universitari del Sagrat Cor, Barcelona
| | - F Heras
- Thoracic Surgery Units, Hospital General Universitario de Valladolid, Valladolid
| | - R Embún
- Thoracic Surgery Units, Hospital Universitario Miguel Servet Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - J J Rivas
- Thoracic Surgery Units, Hospital Universitario Miguel Servet Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
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Abstract
The development of metastases after curative treatment can be seen as a failure. A common justification for the removal of metastases is that the knowledge that they are there may cause psychological distress, a real symptom that may be relieved by their removal. Although it is a commonly used justification for metastasectomy, the authors are unaware of any studies confirming or quantifying the health gain. This article strongly challenges the belief in clinical effectiveness and demonstrates that it is supported neither by a sound biological rationale nor by any good evidence. Reasons are suggested why this unfounded belief has become so prevalent.
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, 4 Taviton Street, University College London, London WC1H 0BT, United Kingdom.
| | - Fergus Macbeth
- Wales Cancer Trials Unit, 6th Floor, Neuadd Meirionnydd, University Hospital of Wales, Heath Park, Cardiff CF14 4YS, United Kingdom
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30
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Management of resectable colorectal lung metastases. Clin Exp Metastasis 2015; 33:285-96. [DOI: 10.1007/s10585-015-9774-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 12/07/2015] [Indexed: 02/07/2023]
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31
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Percutaneous management of pulmonary metastases arising from colorectal cancer; a systematic review. Eur J Surg Oncol 2015; 41:1447-55. [DOI: 10.1016/j.ejso.2015.07.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/03/2015] [Accepted: 07/23/2015] [Indexed: 01/25/2023] Open
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Marron MC, Lora D, Gamez P, Rivas JJ, Embun R, Molins L, de la Cruz J. Agreement Between Computed Tomography and Pathologic Nodule Counts in Colorectal Lung Metastases. Ann Thorac Surg 2015; 101:259-65. [PMID: 26319489 DOI: 10.1016/j.athoracsur.2015.06.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/26/2015] [Accepted: 06/01/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Computed tomography is the most common technique used to estimate the number of pulmonary metastases and their resectability. A lack of agreement between radiologic and surgical pathologic findings could potentially lead to incomplete resection or to rejection of patients for potentially curative treatments. The objective of this study was to estimate the disagreement between the number of radiologic lesions and the number of histologically confirmed malignant lesions excised from patients with pulmonary metastases from colorectal cancer. METHODS This was a multicenter longitudinal study using a national registry. All patients underwent open surgery for pulmonary metastasectomy. RESULTS Radiologic unilateral involvement was documented in 345 of 404 patients (85%); 253 (73%) presented with single nodules. The radiologic and malignant pathologic findings were concordant in 316 (78%) patients. The two independent predictors of discordance between computed tomography and the number of pathologic metastases were the bilateral involvement and the number of radiologic nodules. This model explained 28% of the variability in the disagreement frequency and discriminated between agreement and disagreement in 85% of the patients. Discrepancies increased with the nodule count with an odds ratio of 6.17 (95% confidence interval, 4.08 to 9.33) per additional nodule. For similar nodule counts, a lower disagreement frequency was observed among bilateral cases (odds ratio, 0.2; 95% confidence interval, 0.07 to 0.55). CONCLUSIONS Differences between the radiologic and pathologic findings were documented in 1 of every 5 patients. The correlation was very accurate in patients with single radiologic nodules. However, half of the patients with more nodules showed discrepancies.
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Affiliation(s)
- M Carmen Marron
- Department of Thoracic Surgery, "12 Octubre" University Hospital, Madrid, Spain.
| | - David Lora
- Clinical Research Unit-CIBERESP, "12 Octubre" University Hospital, Madrid, Spain
| | - Pablo Gamez
- Department of Thoracic Surgery, "12 Octubre" University Hospital, Madrid, Spain
| | - Juan J Rivas
- Department of Thoracic Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - Raul Embun
- Department of Thoracic Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - Laureano Molins
- Department of Thoracic Surgery, Sagrat Cor University Hospital, Barcelona, Spain
| | - Javier de la Cruz
- Clinical Research Unit-CIBERESP, "12 Octubre" University Hospital, Madrid, Spain
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Cho JH, Kim S, Namgung M, Choi YS, Kim HK, Zo JI, Shim YM, Kim J. The prognostic importance of the number of metastases in pulmonary metastasectomy of colorectal cancer. World J Surg Oncol 2015. [PMID: 26205014 PMCID: PMC4522996 DOI: 10.1186/s12957-015-0621-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The presence of multiple metastatic pulmonary nodules is a predictor of poor survival after pulmonary metastasectomy. However, there is a paucity of data addressing the exact number of pulmonary metastases over which prognosis becomes grave. The aim of our study is to investigate the prognosis of pulmonary metastasectomy from colorectal cancer (CRC) depending on the number of pulmonary metastases. Methods Patients who had undergone pulmonary metastasectomy for CRC between November 1994 and December 2013 were included. Survival and recurrence patterns were analyzed with regard to the number of pulmonary metastases. Patients were divided into three groups depending on the number of pulmonary metastases that were detected by the final pathologic report: group I—single metastasis; group II—2–3 metastases; and group III—4+ metastases. Results A total of 615 patients who had undergone pulmonary metastasectomy from colorectal cancer were included. The median follow-up period was 31 months (range 2–211 months). The median disease-free interval (DFI) from the time of the primary operation for colorectal cancer was 20 months (range 0–209 months). There were 414 patients in group I (single metastasis), 159 in group II (2–3 metastases), and 42 in group III (4+ metastases). The overall 5-year survival rate was 64.2 %. The 5-year survival rates in groups I, II, and III were 70.0, 56.2, and 33.7 %, respectively (group I vs. II, p < 0.001; group II vs. III, p = 0.012). The 5-year recurrence-free rates were 39.5, 30.6, and 8.5 % in groups I, II, and III, respectively (group I vs. II, p < 0.001; group II vs. III, p = 0.056). Multivariable analysis revealed that age, multiple pulmonary nodules, thoracic lymph node metastasis, and adjuvant chemotherapy are independent predictors of survival. Conclusions The overall survival and recurrence after pulmonary metastasectomy for CRC is dependent on the number of metastases. Surgical treatment can be offered to patients with three or fewer pulmonary metastases. However, more meticulous patient selection is required to decide whether a surgical approach is feasible in patients with four or more pulmonary metastases.
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Affiliation(s)
- Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-dong, Gangnam-gu, Seoul, 135-710, South Korea
| | - Seok Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-dong, Gangnam-gu, Seoul, 135-710, South Korea
| | - Mi Namgung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-dong, Gangnam-gu, Seoul, 135-710, South Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-dong, Gangnam-gu, Seoul, 135-710, South Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-dong, Gangnam-gu, Seoul, 135-710, South Korea
| | - Jae Ill Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-dong, Gangnam-gu, Seoul, 135-710, South Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-dong, Gangnam-gu, Seoul, 135-710, South Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-dong, Gangnam-gu, Seoul, 135-710, South Korea.
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Call S, Rami-Porta R, Embún R, Casas L, Rivas JJ, Molins L, Belda-Sanchís J. Impact of inappropriate lymphadenectomy on lung metastasectomy for patients with metastatic colorectal cancer. Surg Today 2015; 46:471-8. [PMID: 26143245 DOI: 10.1007/s00595-015-1214-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/03/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the characteristics of lymph node assessment in the Spanish Colorectal Metastasectomy Registry (GECMP-CCR) and to analyze and compare the survival of patients with pathological absence or presence of lymph node metastases (LNM) with the survival of those with uncertain lymph node status (uLNs). METHODS A total of 522 patients with lung metastases from colorectal carcinoma were prospectively registered from 2008 to 2010. To confirm the pathologic absence of LNM, systematic nodal dissection or systematic sampling was required, or the lymph node status was coded as uncertain. Disease-specific survival and disease-free survival were calculated by the Kaplan-Meier method with the log-rank test for comparisons. RESULTS Lymphadenectomy was performed in 250 (48%) patients. LNM was found in 25 (10%) of the patients who had lymph node assessment done. The 3- and 5-year disease-specific survival rates according to lymph node status were 73.5 and 58.3% in the absence of LNM, 50.5 and 24.8% when LNM was confirmed, and 69 and 44% for those with uLNs, respectively (p = 0.006). CONCLUSIONS The presence of LNM and uLNs is associated with an increased risk of death. The association of nodal assessment at the time of metastasectomy to identify LNM helps us to refine the postoperative prognosis; therefore, its impact should be properly studied in a prospective clinical trial.
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Affiliation(s)
- Sergi Call
- Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Plaza Dr. Robert, 5, 08221, Terrassa, Barcelona, Spain. .,Department of Morphological Sciences, School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | - Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, and CIBERES Lung Cancer Group, Terrassa, Barcelona, Spain
| | - Raúl Embún
- Department of Thoracic Surgery, Hospital Universitario Miguel Servet, and Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Laura Casas
- Department of Biostatistics and Data Management, Dynamic, Madrid, Spain
| | - Juan J Rivas
- Department of Thoracic Surgery, Hospital Universitario Miguel Servet, and Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Laureano Molins
- Department of Thoracic Surgery, Hospital Universitario Sagrat Cor and Hospital Clinic, Barcelona, Spain
| | - José Belda-Sanchís
- Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Plaza Dr. Robert, 5, 08221, Terrassa, Barcelona, Spain
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Treasure T, Mineo T, Ambrogi V, Fiorentino F. Survival is higher after repeat lung metastasectomy than after a first metastasectomy: Too good to be true? J Thorac Cardiovasc Surg 2015; 149:1249-52. [PMID: 25802136 DOI: 10.1016/j.jtcvs.2015.01.067] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/17/2015] [Accepted: 01/29/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, United Kingdom.
| | - Tommaso Mineo
- Thoracic Surgery, Policlinic Tor Vergata University, Rome, Italy
| | - Vincenzo Ambrogi
- Thoracic Surgery, Policlinic Tor Vergata University, Rome, Italy
| | - Francesca Fiorentino
- Francesca Fiorentino Cardiothoracic Surgery, National Heart and Lung Institute Imperial College London, London, United Kingdom
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Migliore M, Milošević M, Lees B, Treasure T, Maria GD. Finding the evidence for pulmonary metastasectomy in colorectal cancer: the PulMicc trial. Future Oncol 2015; 11:15-8. [DOI: 10.2217/fon.14.207] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
ABSTRACT The PulMiCC trial is a randomized controlled trial testing the effect on survival of pulmonary metastasectomy in patients with colorectal cancer. In stage 1 of the trial patients with treated primary colorectal cancer metastatic to the lungs are invited to consent for protocol-based evaluation of their suitability for metastasectomy. The evaluation is as in current practice and includes PET/CT. A decision for or against metastasectomy may be based on the opinion of the clinicians and the preference of the patient. If there is uncertainty the patient is invited to consent to have the treatment arm assigned by randomization in stage 2 of PulMiCC. More than 300 patients have entered stage 1 and more than 70 are in stage 2.
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Affiliation(s)
- Marcello Migliore
- Division of Thoracic Surgery, Department of Surgery, University of Catania, Italy
| | - Mišel Milošević
- Clinic for Thoracic Surgery, Institute for Pulmonary Diseases of Vojvodina, University of Novi Sad, Serbia
| | - Belinda Lees
- Clinical Trials & Evaluation Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Tom Treasure
- Clinical Operational Research Unit, University College, London, UK
| | - Giuseppe Di Maria
- Pneumology Unit, Department of Clinical & Molecular Bio-Medicine, University of Catania, Italy
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Salah S, Ardissone F, Gonzalez M, Gervaz P, Riquet M, Watanabe K, Zabaleta J, Al-Rimawi D, Toubasi S, Massad E, Lisi E, Hamed OH. Pulmonary metastasectomy in colorectal cancer patients with previously resected liver metastasis: pooled analysis. Ann Surg Oncol 2014; 22:1844-50. [PMID: 25326396 DOI: 10.1245/s10434-014-4173-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Data addressing the outcomes and patterns of recurrence after pulmonary metastasectomy (PM) in patients with colorectal cancer (CRC) and previously resected liver metastasis are limited. METHODS We searched the PubMed database for studies assessing PM in CRC and gathered individual data for patients who had PM and a previous curative liver resection. The influence of potential factors on overall survival (OS) was analyzed through univariate and multivariate analysis. RESULTS Between 1983 and 2009, 146 patients from five studies underwent PM and had previous liver resection. The median interval from resection of liver metastasis until detection of lung metastasis and the median follow-up from PM were 23 and 48 months, respectively. Five-year OS and recurrence-free survival rates calculated from the date of PM were 54.4 and 29.3 %, respectively. Factors predicting inferior OS in univariate analysis included thoracic lymph node (LN) involvement and size of largest lung nodule ≥2 cm. Adjuvant chemotherapy and whether lung metastasis was detected synchronous or metachronous to liver metastasis had no influence on survival. In multivariate analysis, thoracic LN involvement emerged as the only independent factor (hazard ratio 4.86, 95 % confidence interval 1.56-15.14, p = 0.006). CONCLUSIONS PM offers a chance for long-term survival in selected patients with CRC and previously resected liver metastasis. Thoracic LN involvement predicted poor prognosis; therefore, significant efforts should be undertaken for adequate staging of the mediastinum before PM. In addition, adequate intraoperative LN sampling allows proper prognostic stratification and enrollment in novel adjuvant therapy trials.
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Affiliation(s)
- Samer Salah
- Medical Oncology Department, King Hussein Cancer Center, Amman, Jordan,
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Zampino MG, Maisonneuve P, Ravenda PS, Magni E, Casiraghi M, Solli P, Petrella F, Gasparri R, Galetta D, Borri A, Donghi S, Veronesi G, Spaggiari L. Lung Metastases From Colorectal Cancer: Analysis of Prognostic Factors in a Single Institution Study. Ann Thorac Surg 2014; 98:1238-45. [DOI: 10.1016/j.athoracsur.2014.05.048] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/23/2014] [Accepted: 05/05/2014] [Indexed: 12/24/2022]
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Palma DA, Salama JK, Lo SS, Senan S, Treasure T, Govindan R, Weichselbaum R. The oligometastatic state - separating truth from wishful thinking. Nat Rev Clin Oncol 2014; 11:549-57. [PMID: 24958182 DOI: 10.1038/nrclinonc.2014.96] [Citation(s) in RCA: 215] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The oligometastatic paradigm implies that patients who develop a small number of metastatic lesions might achieve long-term survival if all these lesions are ablated with surgery or stereotactic radiotherapy. Clinical data indicate that the number of patients with oligometastatic disease receiving aggressive treatment is increasing rapidly. We examine the key evidence supporting or refuting the existence of an oligometastatic state. Numerous single-arm studies suggest that long-term survival is 'better-than-expected' after ablative treatment. However, the few studies with adequate controls raise the possibility that this long-term survival might not be due to the treatments themselves, but rather to the selection of patients based on favourable inclusion criteria. Furthermore, ablative treatments carry a risk of harming healthy tissue, yet the risk-benefit ratio cannot be quantified if the benefits are unmeasured. If the strategy of treating oligometastases is to gain widespread acceptance as routine clinical practice, there should be stronger evidence supporting its efficacy.
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Affiliation(s)
- David A Palma
- Division of Radiation Oncology, London Health Sciences Centre, 790 Commissioners Road East, London, ON N6A 4L6, Canada
| | - Joseph K Salama
- Department of Radiation Oncology, Duke University School of Medicine, 508 Fulton Street, Durham, NC 27705, USA
| | - Simon S Lo
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Centre, De Boelelaan 1117, PO Box 7057, Amsterdam, 1007 MB, Netherlands
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, 4 Taviton Street, London WC1H 0BT, UK
| | - Ramaswamy Govindan
- Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA
| | - Ralph Weichselbaum
- University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL 60637, USA
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Siriwardena AK, Mason JM, Mullamitha S, Hancock HC, Jegatheeswaran S. Management of colorectal cancer presenting with synchronous liver metastases. Nat Rev Clin Oncol 2014; 11:446-59. [DOI: 10.1038/nrclinonc.2014.90] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Treasure T, Monson K, Fiorentino F, Russell C. The CEA Second-Look Trial: a randomised controlled trial of carcinoembryonic antigen prompted reoperation for recurrent colorectal cancer. BMJ Open 2014; 4:e004385. [PMID: 24823671 PMCID: PMC4025449 DOI: 10.1136/bmjopen-2013-004385] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE In patients who have undergone a potentially curative resection of colorectal cancer, does a 'second-look' operation to resect recurrence, prompted by monthly monitoring of carcinoembryonic antigen, confer a survival benefit? DESIGN A randomised controlled trial recruiting patients from 1982 to 1993 was recovered under the Restoring Invisible and Abandoned Trials (RIAT) initiative. SETTING 58 hospitals in the UK. PARTICIPANTS From 1982 to 1993, 1447 patients were enrolled. Of these 216 met the criteria for carcinoembryonic antigen (CEA) elevation and were randomised to 'Aggressive' or 'Conventional' arms. INTERVENTIONS 'Second-look' surgery with intention to remove any recurrence discovered. PRIMARY OUTCOME MEASURE Survival. RESULTS By February 1993, 91/108 patients had died in the 'Aggressive arm' and 88/108 in the 'Conventional' arm (relative risk=1.16, 95% CI 0.87 to 1.37). By 2011 a further 25 randomised patients had died. Kaplan-Meier analysis showed no difference in long-term survival. CONCLUSIONS The trial was closed in 1993 following a recommendation from the Data Monitoring Committee that it was highly unlikely that any survival advantage would be demonstrated for CEA prompted second-look surgery. This conclusion was confirmed by repeat analysis of survival times after 20 years. TRIAL REGISTRATION NUMBER ISRCTN76694943.
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
| | - Kathryn Monson
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton, UK
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Treasure T, Milošević M, Fiorentino F, Macbeth F. Pulmonary metastasectomy: what is the practice and where is the evidence for effectiveness? Thorax 2014; 69:946-9. [PMID: 24415715 PMCID: PMC4174129 DOI: 10.1136/thoraxjnl-2013-204528] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pulmonary metastasectomy is a commonly performed operation and is tending to increase as part of a concept of personalised treatment for advanced cancer. There have been no randomised trials; belief in effectiveness of metastasectomy is based on registry data and surgical follow-up studies. These retrospective series are comprised predominately of solitary or few metastases with primary resection to metastasectomy intervals longer than 2-3 years. Five-year survival rates of 30-50% are recorded, but as case selection is based on favourable prognostic features, an apparent association between metastasectomy and survival cannot be interpreted as causation. Cancers for which lung metastasectomy is used are considered in four pathological groups. In non-seminomatous germ cell tumour, for which chemotherapy is highly effective, excision of residual pulmonary disease guides future treatment and in particular allows an informed decisions as to further chemotherapy. Sarcoma metastasises predominately to lung and pulmonary metastasectomy for both bone and soft tissues sarcoma is routinely considered as a treatment option but without randomised data. The commonest circumstance for lung and liver metastasectomy is colorectal cancer. Repeated resections and ablations are commonplace but without evidence of effectiveness for either. For melanoma, results are particularly poor, but lung metastases are resected when no other treatment options are available. In this review, the available evidence is considered and the conclusion reached is that in the absence of randomised trials there is uncertainty about effectiveness. A randomised controlled trial, Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC), is in progress and randomised trials in sarcoma seem warranted.
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
| | - Mišel Milošević
- Clinic for Thoracic Surgery, Institute for Pulmonary Diseases of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | - Francesca Fiorentino
- Department of Cardiothoracic Surgery, National Heart and Lung Institute, Imperial College London, London, UK
| | - Fergus Macbeth
- Wales Cancer Trials Unit, Cardiff University, Cardiff, UK
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Treasure T. Pulmonary Metastasectomy for Colorectal Cancer: Recent Reports Prompt a Review of the Available Evidence. CURRENT COLORECTAL CANCER REPORTS 2014; 10:296-302. [PMID: 25191154 PMCID: PMC4149747 DOI: 10.1007/s11888-014-0234-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pulmonary metastasectomy for colorectal cancer is commonplace surgery, but the practice has grown on the basis of follow-up studies. These studies base their conclusion on the effectiveness of metastasectomy on the survival rates at 5 years of very highly selected patients. Three publications in the last year, a registry study, a meta-analysis and a randomised controlled trial of monitoring and early detection of cancer recurrence, prompted a review of the evidence. A critical examination of the evidence suggests that much of the apparent benefit may be due to selection of patients most likely to survive on the basis of well-known prognostic features, explicitly stated in the clinical record. Clinicians also assess their patients over time and do not offer surgery to those with faster progression. Such clinical judgements are of their nature often subtle and undocumented and thus cannot be retrieved from the clinical record. Although some patients may have long survival following pulmonary metastasectomy, and indeed their survival might be believed to be due to resection of pulmonary metastases, how many patients must be operated on to find these survivors? What is the number 'needed to treat'? It may be that of the patients having metastasectomy, for the greater proportion it does not materially alter their survival. A randomised controlled trial to resolve this uncertainty is in progress. The Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) trial is recruiting in Britain and Europe.
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, WC1H 0BT UK
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Rodriguez-Fuster A, Belda-Sanchis J, Aguilo R, Embun R, Mojal S, Call S, Molins L, Rivas de Andres JJ, Zafra JR, Navarrete CP, de la Cruz Lozano J, Rivas de Andres JJ, Flor RE, Freixinet J, Carbajo MC, Rombola CA, Heras F, Molins L, Mier Odriozola JM, Doyague FR, Rodriguez-Fuster A, Arrayas EC, Garay MR, Call S, Araujo EF, Barajas SG, Prim JMG, Gonzalez D, Ramos MB, Sarceda JRJ, Pascual RP, Molina GM, Fernandez MCM, Olaiz BD, Tristan AA, Franco CG, Wins R, Arnau A, Padilla JMC, Carriquiry G, Rosenberg M, Smith D. Morbidity and mortality in a large series of surgical patients with pulmonary metastases of colorectal carcinoma: a prospective multicentre Spanish study (GECMP-CCR-SEPAR). Eur J Cardiothorac Surg 2013; 45:671-6. [DOI: 10.1093/ejcts/ezt459] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Fiorentino F, Treasure T. Pulmonary metastasectomy for colorectal cancer: making the case for a randomized controlled trial in the zone of uncertainty. J Thorac Cardiovasc Surg 2013; 146:748-52. [PMID: 23915919 DOI: 10.1016/j.jtcvs.2013.06.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 06/15/2013] [Accepted: 06/18/2013] [Indexed: 12/29/2022]
Affiliation(s)
- Francesca Fiorentino
- Department of Cardiothoracic Surgery, National Heart and Lung Institute, Imperial College London, London, United Kingdom
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